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To amend sections 173.401, 173.501, 3702.51, 3702.59,
5111.65, 5111.651, 5111.68, 5111.681, 5111.685,
5111.686, 5111.688, 5111.874, 5111.875, and
5111.894; to amend, for the purpose of adopting a
new section number as indicated in parentheses,
section 5111.688 (5111.689); and to enact new
section 5111.688 and section 173.404 of the
Revised Code; and to amend Section 209.20 of Am.
Sub. H.B. 1 of the 128th General Assembly to
revise the waiting list provisions of the
PASSPORT, PACE, and Assisted Living programs, to
revise the law governing the collection of
long-term care facilities' Medicaid debts, and to
revise the law governing the reasons for denying a
Certificate of Need application.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section 1. That sections 173.401, 173.501, 3702.51, 3702.59,
5111.65, 5111.651, 5111.68, 5111.681, 5111.685, 5111.686,
5111.688, 5111.874, 5111.875, and 5111.894 be amended; section
5111.688 (5111.689) be amended for the purpose of adopting a new
section number as indicated in parentheses; and new section
5111.688 and section 173.404 of the Revised Code be enacted to
read as follows:

Sec. 173.401. (A) As used in this section:

"Area agency on aging" has the same meaning as in section
173.14 of the Revised Code.

"Long-term care consultation program" means the program the
department of aging is required to develop under section 173.42 of
the Revised Code.

"Long-term care consultation program administrator" or
"administrator" means the department of aging or, if the
department contracts with an area agency on aging or other entity
to administer the long-term care consultation program for a
particular area, that agency or entity.

"Nursing facility" has the same meaning as in section 5111.20
of the Revised Code.

"PASSPORT waiver" means the federal medicaid waiver granted
by the United States secretary of health and human services that
authorizes the PASSPORT program.

(B) The director of job and family services shall submit to
the United States secretary of health and human services an
amendment to the PASSPORT waiver that authorizes additional
enrollments in the PASSPORT program pursuant to this section.
Beginning with the month following the month in which the United
States secretary approves the amendment and eachThe department
shall establish a home first component of the PASSPORT program
under which eligible individuals may be enrolled in the PASSPORT
program in accordance with this section. An individual is eligible
for the PASSPORT program's home first component if all of the
following apply:

(1) The individual is eligible for the PASSPORT program.

(2) The individual is on the unified waiting list established
under section 173.404 of the Revised Code.

(3) At least one of the following applies:

(a) The individual has been admitted to a nursing facility.

(b) A physician has determined and documented in writing that
the individual has a medical condition that, unless the individual
is enrolled in home and community-based services such as the
PASSPORT program, will require the individual to be admitted to a
nursing facility within thirty days of the physician's
determination.

(c) The individual has been hospitalized and a physician has
determined and documented in writing that, unless the individual
is enrolled in home and community-based services such as the
PASSPORT program, the individual is to be transported directly
from the hospital to a nursing facility and admitted.

(d) Both of the following apply:

(i) The individual is the subject of a report made under
section 5101.61 of the Revised Code regarding abuse, neglect, or
exploitation or such a report referred to a county department of
job and family services under section 5126.31 of the Revised Code
or has made a request to a county department for protective
services as defined in section 5101.60 of the Revised Code.

(ii) A county department of job and family services and an
area agency on aging have jointly documented in writing that,
unless the individual is enrolled in home and community-based
services such as the PASSPORT program, the individual should be
admitted to a nursing facility.

(C) Each month thereafter, each area agency on aging shall
determine whetheridentify individuals who resideresiding in the
area that the area agency on aging serves andwho are on a waiting
listeligible for the home first component of the PASSPORT program
have been admitted to a nursing facility.
IfWhen an area agency
on aging determines thatidentifies such an individual has been
admitted to a nursing facility, the agency shall notify the
long-term care consultation program administrator serving the area
in which the individual resides
about the determination. The
administrator shall determine whether the PASSPORT program is
appropriate for the individual and whether the individual would
rather participate in the PASSPORT program than continue residingor begin to reside in
thea nursing facility. If the
administrator determines that the PASSPORT program is appropriate
for the individual and the individual would rather participate in
the PASSPORT program than continue residingor begin to reside in
thea nursing facility, the administrator shall so notify the
department of aging. On receipt of the notice from the
administrator, the department of aging shall approve the
individual's enrollment in the PASSPORT program regardless of the
PASSPORT program'sunified waiting list and even though the
enrollment causes enrollment in the program to exceed the limit
that would otherwise applyestablished under section 173.404 of
the Revised Code, unless the enrollment would cause the PASSPORT
program to exceed any limit on the number of individuals who may
be enrolled in the program as set by the United States secretary
of health and human services in the PASSPORT waiver.

(D) Each quarter, the department of aging shall certify to
the director of budget and management the estimated increase in
costs of the PASSPORT program resulting from enrollment of
individuals in the PASSPORT program pursuant to this section.

Sec. 173.404. (A) As used in this section:

(1) "Department of aging-administered medicaid waiver
component" means each of the following:

(a) The PASSPORT program created under section 173.40 of the
Revised Code;

(b) The choices program created under section 173.403 of the
Revised Code;

(c) The assisted living program created under section 5111.89
of the Revised Code.

(2) "PACE program" means the component of the medicaid
program the department of aging administers pursuant to section
173.50 of the Revised Code.

(B) The department of aging shall establish a unified waiting
list for department of aging-administered medicaid waiver
components and the PACE program. Only individuals eligible for a
department of aging-administered medicaid waiver component or the
PACE program may be placed on the unified waiting list.

Sec. 173.501. (A) As used in this section:

"Nursing facility" has the same meaning as in section 5111.20
of the Revised Code.

"PACE provider" has the same meaning as in 42 U.S.C.
1396u-4(a)(3).

(B) The department of aging shall establish a home first
component of the PACE program under which eligible individuals may
be enrolled in the PACE program in accordance with this section.
An individual is eligible for the PACE program's home first
component if all of the following apply:

(1) The individual is eligible for the PACE program.

(2) The individual is on the unified waiting list established
under section 173.404 of the Revised Code.

(3) At least one of the following applies:

(a) The individual has been admitted to a nursing facility.

(b) A physician has determined and documented in writing that
the individual has a medical condition that, unless the individual
is enrolled in home and community-based services such as the PACE
program, will require the individual to be admitted to a nursing
facility within thirty days of the physician's determination.

(c) The individual has been hospitalized and a physician has
determined and documented in writing that, unless the individual
is enrolled in home and community-based services such as the PACE
program, the individual is to be transported directly from the
hospital to a nursing facility and admitted.

(d) Both of the following apply:

(i) The individual is the subject of a report made under
section 5101.61 of the Revised Code regarding abuse, neglect, or
exploitation or such a report referred to a county department of
job and family services under section 5126.31 of the Revised Code
or has made a request to a county department for protective
services as defined in section 5101.60 of the Revised Code.

(ii) A county department of job and family services and an
area agency on aging have jointly documented in writing that,
unless the individual is enrolled in home and community-based
services such as the PACE program, the individual should be
admitted to a nursing facility.

(C) Each month, the department of aging shall determine
whetheridentify individuals who are on a waiting listeligible
for the home first component of the PACE program
have been
admitted to a nursing facility. IfWhen the department
determines
thatidentifies such an individual has been admitted to a nursing
facility, the department shall notify the PACE provider serving
the area in which the individual resides about the determination.
The PACE provider shall determine whether the PACE program is
appropriate for the individual and whether the individual would
rather participate in the PACE program than continue residingor
begin to reside in
thea nursing facility. If the PACE provider
determines that the PACE program is appropriate for the individual
and the individual would rather participate in the PACE program
than continue
residingor begin to reside in thea nursing
facility, the PACE provider shall so notify the department of
aging. On receipt of the notice from the PACE provider, the
department of aging shall approve the individual's enrollment in
the PACE program in accordance with priorities established in
rules adopted under section 173.50 of the Revised Code. Each

(D) Each quarter, the department of aging shall certify to
the director of budget and management the estimated increase in
costs of the PACE program resulting from enrollment of individuals
in the PACE program pursuant to this section.

Sec. 3702.51. As used in sections 3702.51 to 3702.62 of the
Revised Code:

(A) "Applicant" means any person that submits an application
for a certificate of need and who is designated in the application
as the applicant.

(F) "Health service agency" means an agency designated to
serve a health service area in accordance with section 3702.58 of
the Revised Code.

(G) "Health care facility" means:

(1) A hospital registered under section 3701.07 of the
Revised Code;

(2) A nursing home licensed under section 3721.02 of the
Revised Code, or by a political subdivision certified under
section 3721.09 of the Revised Code;

(3) A county home or a county nursing home as defined in
section 5155.31 of the Revised Code that is certified under Title
XVIII or XIX of the "Social Security Act," 49 Stat. 620 (1935), 42
U.S.C.A. 301, as amended;

(4) A freestanding dialysis center;

(5) A freestanding inpatient rehabilitation facility;

(6) An ambulatory surgical facility;

(7) A freestanding cardiac catheterization facility;

(8) A freestanding birthing center;

(9) A freestanding or mobile diagnostic imaging center;

(10) A freestanding radiation therapy center.

A health care facility does not include the offices of
private physicians and dentists whether for individual or group
practice, residential facilities licensed under section 5123.19 of
the Revised Code, or an institution for the sick that is operated
exclusively for patients who use spiritual means for healing and
for whom the acceptance of medical care is inconsistent with their
religious beliefs, accredited by a national accrediting
organization, exempt from federal income taxation under section
501 of the Internal Revenue Code of 1986, 100 Stat. 2085, 26
U.S.C.A. 1, as amended, and providing twenty-four hour nursing
care pursuant to the exemption in division (E) of section 4723.32
of the Revised Code from the licensing requirements of Chapter
4723. of the Revised Code.

(H) "Medical equipment" means a single unit of medical
equipment or a single system of components with related functions
that is used to provide health services.

(I) "Third-party payer" means a health insuring corporation
licensed under Chapter 1751. of the Revised Code, a health
maintenance organization as defined in division (K) of this
section, an insurance company that issues sickness and accident
insurance in conformity with Chapter 3923. of the Revised Code, a
state-financed health insurance program under Chapter 3701.,
4123., or 5111. of the Revised Code, or any self-insurance plan.

(J) "Government unit" means the state and any county,
municipal corporation, township, or other political subdivision of
the state, or any department, division, board, or other agency of
the state or a political subdivision.

(K) "Health maintenance organization" means a public or
private organization organized under the law of any state that is
qualified under section 1310(d) of Title XIII of the "Public
Health Service Act," 87 Stat. 931 (1973), 42 U.S.C. 300e-9.

(L) "Existing health care facility" means either of the
following:

(1) A health care facility that is licensed or otherwise
authorized to operate in this state in accordance with applicable
law, including a county home or a county nursing home that is
certified as of February 1, 2008, under Title XVIII or Title XIX
of the "Social Security Act," 49 Stat. 620 (1935), 42 U.S.C. 301,
as amended, is staffed and equipped to provide health care
services, and is actively providing health services;

(2) A health care facility that is licensed or otherwise
authorized to operate in this state in accordance with applicable
law, including a county home or a county nursing home that is
certified as of February 1, 2008, under Title XVIII or Title XIX
of the "Social Security Act," 49 Stat. 620 (1935), 42 U.S.C. 301,
as amended, or that has beds registered under section 3701.07 of
the Revised Code as skilled nursing beds or long-term care beds
and has provided services for at least three hundred sixty-five
consecutive days within the twenty-four months immediately
preceding the date a certificate of need application is filed with
the director of health.

(M) "State" means the state of Ohio, including, but not
limited to, the general assembly, the supreme court, the offices
of all elected state officers, and all departments, boards,
offices, commissions, agencies, institutions, and other
instrumentalities of the state of Ohio. "State" does not include
political subdivisions.

(N) "Political subdivision" means a municipal corporation,
township, county, school district, and all other bodies corporate
and politic responsible for governmental activities only in
geographic areas smaller than that of the state to which the
sovereign immunity of the state attaches.

(O) "Affected person" means:

(1) An applicant for a certificate of need, including an
applicant whose application was reviewed comparatively with the
application in question;

(2) The person that requested the reviewability ruling in
question;

(3) Any person that resides or regularly uses health care
facilities within the geographic area served or to be served by
the health care services that would be provided under the
certificate of need or reviewability ruling in question;

(4) Any health care facility that is located in the health
service area where the health care services would be provided
under the certificate of need or reviewability ruling in question;

(5) Third-party payers that reimburse health care facilities
for services in the health service area where the health care
services would be provided under the certificate of need or
reviewability ruling in question;

(6) Any other person who testified at a public hearing held
under division (B) of section 3702.52 of the Revised Code or
submitted written comments in the course of review of the
certificate of need application in question.

(P) "Osteopathic hospital" means a hospital registered under
section 3701.07 of the Revised Code that advocates osteopathic
principles and the practice and perpetuation of osteopathic
medicine by doing any of the following:

(1) Maintaining a department or service of osteopathic
medicine or a committee on the utilization of osteopathic
principles and methods, under the supervision of an osteopathic
physician;

(2) Maintaining an active medical staff, the majority of
which is comprised of osteopathic physicians;

(3) Maintaining a medical staff executive committee that has
osteopathic physicians as a majority of its members.

(Q) "Ambulatory surgical facility" has the same meaning as in
section 3702.30 of the Revised Code.

(R) Except as provided in division (S) of this section,
"reviewable activity" means any of the following activities:

(1) The establishment, development, or construction of a new
long-term care facility;

(2) The replacement of an existing long-term care facility;

(3) The renovation of a long-term care facility that involves
a capital expenditure of two million dollars or more, not
including expenditures for equipment, staffing, or operational
costs;

(4) Either of the following changes in long-term care bed
capacity:

(a) An increase in bed capacity;

(b) A relocation of beds from one physical facility or site
to another, excluding the relocation of beds within a long-term
care facility or among buildings of a long-term care facility at
the same site.

(5) Any change in the health services, bed capacity, or site,
or any other failure to conduct the reviewable activity in
substantial accordance with the approved application for which a
certificate of need concerning long-term care beds was granted, if
the change is made within five years after the implementation of
the reviewable activity for which the certificate was granted;

(6) The expenditure of more than one hundred ten per cent of
the maximum expenditure specified in a certificate of need
concerning long-term care beds.

(S) "Reviewable activity" does not include any of the
following activities:

(1) Acquisition of computer hardware or software;

(2) Acquisition of a telephone system;

(3) Construction or acquisition of parking facilities;

(4) Correction of cited deficiencies that are in violation of
federal, state, or local fire, building, or safety laws and rules
and that constitute an imminent threat to public health or safety;

(5) Acquisition of an existing health care facility that does
not involve a change in the number of the beds, by service, or in
the number or type of health services;

(6) Correction of cited deficiencies identified by
accreditation surveys of the joint commission on accreditation of
healthcare organizations or of the American osteopathic
association;

(7) Acquisition of medical equipment to replace the same or
similar equipment for which a certificate of need has been issued
if the replaced equipment is removed from service;

(8) Mergers, consolidations, or other corporate
reorganizations of health care facilities that do not involve a
change in the number of beds, by service, or in the number or type
of health services;

(11) Acquisition of medical equipment to conduct research
required by the United States food and drug administration or
clinical trials sponsored by the national institute of health. Use
of medical equipment that was acquired without a certificate of
need under division (S)(11) of this section and for which
premarket approval has been granted by the United States food and
drug administration to provide services for which patients or
reimbursement entities will be charged shall be a reviewable
activity.

(12) Removal of asbestos from a health care facility.

Only that portion of a project that meets the requirements of
this division is not a reviewable activity.

(T) "Small rural hospital" means a hospital that is located
within a rural area, has fewer than one hundred beds, and to which
fewer than four thousand persons were admitted during the most
recent calendar year.

(U) "Children's hospital" means any of the following:

(1) A hospital registered under section 3701.07 of the
Revised Code that provides general pediatric medical and surgical
care, and in which at least seventy-five per cent of annual
inpatient discharges for the preceding two calendar years were
individuals less than eighteen years of age;

(2) A distinct portion of a hospital registered under section
3701.07 of the Revised Code that provides general pediatric
medical and surgical care, has a total of at least one hundred
fifty registered pediatric special care and pediatric acute care
beds, and in which at least seventy-five per cent of annual
inpatient discharges for the preceding two calendar years were
individuals less than eighteen years of age;

(3) A distinct portion of a hospital, if the hospital is
registered under section 3701.07 of the Revised Code as a
children's hospital and the children's hospital meets all the
requirements of division (U)(1) of this section.

(V) "Long-term care facility" means any of the following:

(1) A nursing home licensed under section 3721.02 of the
Revised Code or by a political subdivision certified under section
3721.09 of the Revised Code;

(2) The portion of any facility, including a county home or
county nursing home, that is certified as a skilled nursing
facility or a nursing facility under Title XVIII or XIX of the
"Social Security Act";

(3) The portion of any hospital that contains beds registered
under section 3701.07 of the Revised Code as skilled nursing beds
or long-term care beds.

(W) "Long-term care bed" means a bed in a long-term care
facility.

(X) "Freestanding birthing center" means any facility in
which deliveries routinely occur, regardless of whether the
facility is located on the campus of another health care facility,
and which is not licensed under Chapter 3711. of the Revised Code
as a level one, two, or three maternity unit or a limited
maternity unit.

(Y)(1) "Reviewability ruling" means a ruling issued by the
director of health under division (A) of section 3702.52 of the
Revised Code as to whether a particular proposed project is or is
not a reviewable activity.

(2) "Nonreviewability ruling" means a ruling issued under
that division that a particular proposed project is not a
reviewable activity.

(Z)(1) "Metropolitan statistical area" means an area of this
state designated a metropolitan statistical area or primary
metropolitan statistical area in United States office of
management and budget bulletin no. 93-17, June 30, 1993, and its
attachments.

(2) "Rural area" means any area of this state not located
within a metropolitan statistical area.

(AA) "County nursing home" has the same meaning as in section
5155.31 of the Revised Code.

(BB) "Principal participant" means both of the following:

(1) A person who has an ownership or controlling interest of
at least five per cent in an applicant, in a health care facility
that is the subject of an application for a certificate of need,
or in the owner or operator of the applicant or such a facility;

(2) An officer, director, trustee, or general partner of an
applicant, of a health care facility that is the subject of an
application for a certificate of need, or of the owner or operator
of the applicant or such a facility.

(CC) "Actual harm but not immediate jeopardy deficiency"
means a deficiency that, under 42 C.F.R. 488.404, either
constitutes a pattern of deficiencies resulting in actual harm
that is not immediate jeopardy or represents widespread
deficiencies resulting in actual harm that is not immediate
jeopardy.

(DD) "Immediate jeopardy deficiency" means a deficiency that,
under 42 C.F.R. 488.404, either constitutes a pattern of
deficiencies resulting in immediate jeopardy to resident health or
safety or represents widespread deficiencies resulting in
immediate jeopardy to resident health or safety.

Sec. 3702.59. (A) The director of health shall accept for
review certificate of need applications as provided in sections
3702.592, 3702.593, and 3702.594 of the Revised Code.

(B)(1) The director shall not approve an application for a
certificate of need for the addition of long-term care beds to an
existing health care facility or for the development of a new
health care facility if any of the following apply:

(1)(a) The existing health care facility in which the beds
are being placed has one or more waivers for life safety code
deficiencies, one or more state fire code violations, or one or
more state building code violations, and the project identified in
the application does not propose to correct all life safety code
deficiencies for which a waiver has been granted, all state fire
code violations, and all state building code violations at the
existing health care facility in which the beds are being placed;

(2)(b) During the sixty-month period preceding the filing of
the application, a notice of proposed license revocation was
issued under section 3721.03 of the Revised Code for the existing
health care facility in which the beds are being placed or a
nursing home owned or operated by the applicant or the corporation
or other business that operates or seeks to operate the health
care facility in which the beds are being placeda principal
participant.

(3)(c) During the period that precedes the filing of the
application and is encompassed by the three most recent standard
surveys of the existing health care facility in which the beds are
being placed, theany of the following occurred:

(i) The facility was cited on three or more separate
occasions for final, nonappealable actual harm but not immediate
jeopardy deficiencies that, under 42 C.F.R. 488.404, either
constitute a pattern of deficiencies resulting in actual harm that
is not immediate jeopardy or are widespread deficiencies resulting
in actual harm that is not immediate jeopardy.

(4) During the period that precedes the filing of the
application and is encompassed by the three most recent standard
surveys of the existing health care facility in which the beds are
being placed, the(ii) The facility was cited on two or more
separate occasions for final, nonappealable immediate jeopardy
deficiencies that, under 42 C.F.R. 488.404, either constitute a
pattern of deficiencies resulting in immediate jeopardy to
resident health or safety or are widespread deficiencies resulting
in immediate jeopardy to resident health or safety.

(5) During the period that precedes the filing of the
application and is encompassed by the three most recent standard
surveys of the existing health care facility in which the beds are
being placed, more(iii) The facility was cited on two separate
occasions for final, nonappealable actual harm but not immediate
jeopardy deficiencies and on one occasion for a final,
nonappealable immediate jeopardy deficiency.

(d) More than two nursing homes owned or operated in this
state by the applicant or the person who operates the facility in
which the beds are being placeda principal participant or, if the
applicant or persona principal participant owns or operates more
than twenty nursing homes in this state, more than ten per cent of
those nursing homes, were each cited onduring the period that
precedes the filing of the application for the certificate of need
and is encompassed by the three most recent standard surveys of
the nursing homes that were so cited in any of the following
manners:

(i) On three or more separate occasions for final,
nonappealable actual harm but not immediate jeopardy deficiencies
that, under 42 C.F.R. 488.404, either constitute a pattern of
deficiencies resulting in actual harm that is not immediate
jeopardy or are widespread deficiencies resulting in actual harm
that is not immediate jeopardy.

(6) During the period that precedes the filing of the
application and is encompassed by the three most recent standard
surveys of the existing health care facility in which the beds are
being placed, more than two nursing homes operated in this state
by the applicant or the person who operates the facility in which
the beds are being placed or, if the applicant or person operates
more than twenty nursing homes in this state, more than ten per
cent of those nursing homes, were each cited on;

(ii) On two or more separate occasions for final,
nonappealable immediate jeopardy deficiencies
that, under 42
C.F.R. 488.404, either constitute a pattern of deficiencies
resulting in immediate jeopardy to resident health or safety or
are widespread deficiencies resulting in immediate jeopardy to
resident health or safety;

(iii) On two separate occasions for final, nonappealable
actual harm but not immediate jeopardy deficiencies and on one
occasion for a final, nonappealable immediate jeopardy deficiency.

(7) During the sixty-month period preceding the filing of the
application, the applicant has violated this chapter on two or
more separate occasions.

(2) In applying divisions (B)(1)(a) to (6)(d) of this
section, the director shall not consider deficiencies or
violations cited before the
current operatorapplicant or a
principal participant acquired or began to own or operate the
health care facility at which the deficiencies or violations were
cited. The director may disregard deficiencies
and violations
cited after the health care facility was acquired or began to be
operated by the current operatorapplicant or a principal
participant if the deficiencies or violations were attributable to
circumstances that arose under the previous
owner or operator and
the
current operatorapplicant or principal participant has
implemented measures to alleviate the circumstances. In the case
of an application proposing development of a new health care
facility by relocation of beds, the director shall not consider
deficiencies or violations that were solely attributable to the
physical plant of the existing health care facility from which the
beds are being relocated.

(C) The director also shall accept for review any application
for the conversion of infirmary beds to long-term care beds if the
infirmary meets all of the following conditions:

(1) Is operated exclusively by a religious order;

(2) Provides care exclusively to members of religious orders
who take vows of celibacy and live by virtue of their vows within
the orders as if related;

(3) Was providing care exclusively to members of such a
religious order on January 1, 1994.

At no time shall individuals other than those described in
division (C)(2) of this section be admitted to a facility to use
beds for which a certificate of need is approved under this
division.

Sec. 5111.65. As used in sections 5111.65 to 5111.6885111.689 of the Revised Code:

(A) "Affiliated operator" means an operator affiliated with
either of the following:

(1) The exiting operator for whom the affiliated operator is
to assume liability for the entire amount of the exiting
operator's debt under the medicaid program or the portion of the
debt that represents the franchise permit fee the exiting operator
owes;

(2) The entering operator involved in the change of operator
with the exiting operator specified in division (A)(1) of this
section.

(B) "Change of operator" means an entering operator becoming
the operator of a nursing facility or intermediate care facility
for the mentally retarded in the place of the exiting operator.

(1) Actions that constitute a change of operator include the
following:

(a) A change in an exiting operator's form of legal
organization, including the formation of a partnership or
corporation from a sole proprietorship;

(b) A transfer of all the exiting operator's ownership
interest in the operation of the facility to the entering
operator, regardless of whether ownership of any or all of the
real property or personal property associated with the facility is
also transferred;

(c) A lease of the facility to the entering operator or the
exiting operator's termination of the exiting operator's lease;

(d) If the exiting operator is a partnership, dissolution of
the partnership;

(e) If the exiting operator is a partnership, a change in
composition of the partnership unless both of the following apply:

(i) The change in composition does not cause the
partnership's dissolution under state law.

(ii) The partners agree that the change in composition does
not constitute a change in operator.

(f) If the operator is a corporation, dissolution of the
corporation, a merger of the corporation into another corporation
that is the survivor of the merger, or a consolidation of one or
more other corporations to form a new corporation.

(2) The following, alone, do not constitute a change of
operator:

(a) A contract for an entity to manage a nursing facility or
intermediate care facility for the mentally retarded as the
operator's agent, subject to the operator's approval of daily
operating and management decisions;

(b) A change of ownership, lease, or termination of a lease
of real property or personal property associated with a nursing
facility or intermediate care facility for the mentally retarded
if an entering operator does not become the operator in place of
an exiting operator;

(c) If the operator is a corporation, a change of one or more
members of the corporation's governing body or transfer of
ownership of one or more shares of the corporation's stock, if the
same corporation continues to be the operator.

(B)(C) "Effective date of a change of operator" means the day
the entering operator becomes the operator of the nursing facility
or intermediate care facility for the mentally retarded.

(C)(D) "Effective date of a facility closure" means the last
day that the last of the residents of the nursing facility or
intermediate care facility for the mentally retarded resides in
the facility.

(D)(E) "Effective date of a voluntary termination" means the
day the intermediate care facility for the mentally retarded
ceases to accept medicaid patients.

(E)(F) "Effective date of a voluntary withdrawal of
participation" means the day the nursing facility ceases to accept
new medicaid patients other than the individuals who reside in the
nursing facility on the day before the effective date of the
voluntary withdrawal of participation.

(F)(G) "Entering operator" means the person or government
entity that will become the operator of a nursing facility or
intermediate care facility for the mentally retarded when a change
of operator occurs.

(G)(H) "Exiting operator" means any of the following:

(1) An operator that will cease to be the operator of a
nursing facility or intermediate care facility for the mentally
retarded on the effective date of a change of operator;

(2) An operator that will cease to be the operator of a
nursing facility or intermediate care facility for the mentally
retarded on the effective date of a facility closure;

(3) An operator of an intermediate care facility for the
mentally retarded that is undergoing or has undergone a voluntary
termination;

(4) An operator of a nursing facility that is undergoing or
has undergone a voluntary withdrawal of participation.

(H)(I)(1) "Facility closure" means discontinuance of the use
of the building, or part of the building, that houses the facility
as a nursing facility or intermediate care facility for the
mentally retarded that results in the relocation of all of the
facility's residents. A facility closure occurs regardless of any
of the following:

(a) The operator completely or partially replacing the
facility by constructing a new facility or transferring the
facility's license to another facility;

(b) The facility's residents relocating to another of the
operator's facilities;

(c) Any action the department of health takes regarding the
facility's certification under Title XIX of the "Social Security
Act," 79 Stat. 286 (1965), 42 U.S.C. 1396, as amended, that may
result in the transfer of part of the facility's survey findings
to another of the operator's facilities;

(d) Any action the department of health takes regarding the
facility's license under Chapter 3721. of the Revised Code;

(e) Any action the department of developmental disabilities
takes regarding the facility's license under section 5123.19 of
the Revised Code.

(2) A facility closure does not occur if all of the
facility's residents are relocated due to an emergency evacuation
and one or more of the residents return to a medicaid-certified
bed in the facility not later than thirty days after the
evacuation occurs.

(I)(J) "Fiscal year," "franchise permit fee," "intermediate
care facility for the mentally retarded," "nursing facility,"
"operator," "owner," and "provider agreement" have the same
meanings as in section 5111.20 of the Revised Code.

(J)(K) "Voluntary termination" means an operator's voluntary
election to terminate the participation of an intermediate care
facility for the mentally retarded in the medicaid program but to
continue to provide service of the type provided by a residential
facility as defined in section 5123.19 of the Revised Code.

(K)(L)"Voluntary withdrawal of participation" means an
operator's voluntary election to terminate the participation of a
nursing facility in the medicaid program but to continue to
provide service of the type provided by a nursing facility.

Sec. 5111.651. Sections 5111.65 to 5111.6885111.689 of the
Revised Code do not apply to a nursing facility or intermediate
care facility for the mentally retarded that undergoes a facility
closure, voluntary termination, voluntary withdrawal of
participation, or change of operator on or before September 30,
2005, if the exiting operator provided written notice of the
facility closure, voluntary termination, voluntary withdrawal of
participation, or change of operator to the department of job and
family services on or before June 30, 2005.

Sec. 5111.68. (A) On receipt of a written notice under
section 5111.66 of the Revised Code of a facility closure,
voluntary termination, or voluntary withdrawal of participation or
a written notice under section 5111.67 of the Revised Code of a
change of operator, the department of job and family services
shall determineestimate the amount of any overpayments made under
the medicaid program to the exiting operator, including
overpayments the exiting operator disputes, and other actual and
potential debts the exiting operator owes or may owe to the
department and United States centers for medicare and medicaid
services under the medicaid program, including a franchise permit
fee. In determining

(B) In estimating the exiting operator's other actual and
potential debts to the department and the United States centers
for medicare and medicaid services under the medicaid program, the
department shall includeuse a debt estimation methodology the
director of job and family services shall establish in rules
adopted under section 5111.689 of the Revised Code. The
methodology shall provide for estimating all of the following that
the department determines isare applicable:

(1) Refunds due the department under section 5111.27 of the
Revised Code;

(2) Interest owed to the department and United States centers
for medicare and medicaid services;

(3) Final civil monetary and other penalties for which all
right of appeal has been exhausted;

(4) Money owed the department and United States centers for
medicare and medicaid services from any outstanding final fiscal
audit, including a final fiscal audit for the last fiscal year or
portion thereof in which the exiting operator participated in the
medicaid program;

(5) Other amounts the department determines are applicable.

(B) If the department is unable to determine the amount of
the overpayments and other debts for any period before the
effective date of the entering operator's provider agreement or
the effective date of the facility closure, voluntary termination,
or voluntary withdrawal of participation, the department shall
make a reasonable estimate of the overpayments and other debts for
the period. The department shall make the estimate using
information available to the department, including prior
determinations of overpayments and other debts.

(C) The department shall provide the exiting operator written
notice of the department's estimate under division (A) of this
section not later than thirty days after the department receives
the notice under section 5111.66 of the Revised Code of the
facility closure, voluntary termination, or voluntary withdrawal
of participation or the notice under section 5111.67 of the
Revised Code of the change of operator. The department's written
notice shall include the basis for the estimate.

Sec. 5111.681. (A) Except as provided in divisiondivisions
(B) and (C) of this section, the department of job and family
services shallmay withhold the greater of the following from
payment due an exiting operator under the medicaid program:

(1) Thethe total amount of any overpayments made under the
medicaid program to the exiting operator, including overpayments
the exiting operator disputes, and other actual and potential
debts, including any unpaid penalties,specified in the notice
provided under division (C) of section 5111.68 of the Revised Code
that the exiting operator owes or may owe to the department and
United States centers for medicare and medicaid services under the
medicaid program;

(2) An amount equal to the average amount of monthly payments
to the exiting operator under the medicaid program for the
twelve-month period immediately preceding the month that includes
the last day the exiting operator's provider agreement is in
effect or, in the case of a voluntary withdrawal of participation,
the effective date of the voluntary withdrawal of participation.

(B) TheIn the case of a change of operator and subject to
division (D) of this section, the following shall apply regarding
a withholding under division (A) of this section if the exiting
operator or entering operator or an affiliated operator executes a
successor liability agreement meeting the requirements of division
(E) of this section:

(1) If the exiting operator, entering operator, or affiliated
operator assumes liability for the total, actual amount of debt
the exiting operator owes the department and the United States
centers for medicare and medicaid services under the medicaid
program as determined under section 5111.685 of the Revised Code,
the department may chooseshall not to make the withholding
under
division (A) of this section if an entering operator does both of
the following:

(1) Enters into a nontransferable, unconditional, written
agreement with the department to pay the department any debt the
exiting operator owes the department under the medicaid program;

(2) Provides the department a copy of the entering operator's
balance sheet that assists the department in determining whether
to make the withholding under division (A) of this section.

(2) If the exiting operator, entering operator, or affiliated
operator assumes liability for only the portion of the amount
specified in division (B)(1) of this section that represents the
franchise permit fee the exiting operator owes, the department
shall withhold not more than the difference between the total
amount specified in the notice provided under division (C) of
section 5111.68 of the Revised Code and the amount for which the
exiting operator, entering operator, or affiliated operator
assumes liability.

(C) In the case of a voluntary termination, voluntary
withdrawal of participation, or facility closure and subject to
division (D) of this section, the following shall apply regarding
a withholding under division (A) of this section if the exiting
operator or an affiliated operator executes a successor liability
agreement meeting the requirements of division (E) of this
section:

(1) If the exiting operator or affiliated operator assumes
liability for the total, actual amount of debt the exiting
operator owes the department and the United States centers for
medicare and medicaid services under the medicaid program as
determined under section 5111.685 of the Revised Code, the
department shall not make the withholding.

(2) If the exiting operator or affiliated operator assumes
liability for only the portion of the amount specified in division
(C)(1) of this section that represents the franchise permit fee
the exiting operator owes, the department shall withhold not more
than the difference between the total amount specified in the
notice provided under division (C) of section 5111.68 of the
Revised Code and the amount for which the exiting operator or
affiliated operator assumes liability.

(D) For an exiting operator or affiliated operator to be
eligible to enter into a successor liability agreement under
division (B) or (C) of this section, both of the following must
apply:

(1) The exiting operator or affiliated operator must have one
or more valid provider agreements, other than the provider
agreement for the nursing facility or intermediate care facility
for the mentally retarded that is the subject of the voluntary
termination, voluntary withdrawal of participation, facility
closure, or change of operator;

(2) During the twelve-month period preceding the month in
which the department receives the notice of the voluntary
termination, voluntary withdrawal of participation, or facility
closure under section 5111.66 of the Revised Code or the notice of
the change of operator under section 5111.67 of the Revised Code,
the average monthly medicaid payment made to the exiting operator
or affiliated operator pursuant to the exiting operator's or
affiliated operator's one or more provider agreements, other than
the provider agreement for the nursing facility or intermediate
care facility for the mentally retarded that is the subject of the
voluntary termination, voluntary withdrawal of participation,
facility closure, or change of operator, must equal at least
ninety per cent of the sum of the following:

(a) The average monthly medicaid payment made to the exiting
operator pursuant to the exiting operator's provider agreement for
the nursing facility or intermediate care facility for the
mentally retarded that is the subject of the voluntary
termination, voluntary withdrawal of participation, facility
closure, or change of operator;

(b) Whichever of the following apply:

(i) If the exiting operator or affiliated operator has
assumed liability under one or more other successor liability
agreements, the total amount for which the exiting operator or
affiliated operator has assumed liability under the other
successor liability agreements;

(ii) If the exiting operator or affiliated operator has not
assumed liability under any other successor liability agreements,
zero.

(E) A successor liability agreement executed under this
section must comply with all of the following:

(1) It must provide for the operator who executes the
successor liability agreement to assume liability for either of
the following as specified in the agreement:

(a) The total, actual amount of debt the exiting operator
owes the department and the United States centers for medicare and
medicaid services under the medicaid program as determined under
section 5111.685 of the Revised Code;

(b) The portion of the amount specified in division (E)(1)(a)
of this section that represents the franchise permit fee the
exiting operator owes.

(2) It may not require the operator who executes the
successor liability agreement to furnish a surety bond.

(3) It must provide that the department, after determining
under section 5111.685 of the Revised Code the actual amount of
debt the exiting operator owes the department and United States
centers for medicare and medicaid services under the medicaid
program, may deduct the lesser of the following from medicaid
payments made to the operator who executes the successor liability
agreement:

(a) The total, actual amount of debt the exiting operator
owes the department and the United States centers for medicare and
medicaid services under the medicaid program as determined under
section 5111.685 of the Revised Code;

(b) The amount for which the operator who executes the
successor liability agreement assumes liability under the
agreement.

(4) It must provide that the deductions authorized by
division (E)(3) of this section are to be made for a number of
months, not to exceed six, agreed to by the operator who executes
the successor liability agreement and the department or, if the
operator who executes the successor liability agreement and
department cannot agree on a number of months that is less than
six, a greater number of months determined by the attorney general
pursuant to a claims collection process authorized by statute of
this state.

(5) It must provide that, if the attorney general determines
the number of months for which the deductions authorized by
division (E)(3) of this section are to be made, the operator who
executes the successor liability agreement shall pay, in addition
to the amount collected pursuant to the attorney general's claims
collection process, the part of the amount so collected that, if
not for division (G) of this section, would be required by section
109.081 of the Revised Code to be paid into the attorney general
claims fund.

(F) Execution of a successor liability agreement does not
waive an exiting operator's right to contest the amount specified
in the notice the department provides the exiting operator under
division (C) of section 5111.68 of the Revised Code.

(G) Notwithstanding section 109.081 of the Revised Code, the
entire amount that the attorney general, whether by employees or
agents of the attorney general or by special counsel appointed
pursuant to section 109.08 of the Revised Code, collects under a
successor liability agreement, other than the additional amount
the operator who executes the agreement is required by division
(E)(5) of this section to pay, shall be paid to the department of
job and family services for deposit into the appropriate fund. The
additional amount that the operator is required to pay shall be
paid into the state treasury to the credit of the attorney general
claims fund created under section 109.081 of the Revised Code.

Sec. 5111.685. The department of job and family services
shall determine the actual amount of debt an exiting operator owes
the department and the United States centers for medicare and
medicaid services under the medicaid program by completing all
final fiscal audits not already completed and performing all other
appropriate actions the department determines to be necessary. The
department shall issue aan initial debt summary report on this
matter not later than ninetysixty days after the date the exiting
operator files the properly completed cost report required by
section 5111.682 of the Revised Code with the department or, if
the department waives the cost report requirement for the exiting
operator, ninetysixty days after the date the department waives
the cost report requirement.
The report shall include the
department's findings and the amount of debt the department
determines the exiting operator owes the department and United
States centers for medicare and medicaid services under the
medicaid program. Only the parts of the report that are subject to
an adjudication as specified in section 5111.30 of the Revised
Code are subject to an adjudication conductedThe initial debt
summary report becomes the final debt summary report thirty-one
days after the department issues the initial debt summary report
unless the exiting operator, or an affiliated operator who
executes a successor liability agreement under section 5111.681 of
the Revised Code, requests a review before that date.

The exiting operator, and an affiliated operator who executes
a successor liability agreement under section 5111.681 of the
Revised Code, may request a review to contest any of the
department's findings included in the initial debt summary report.
The request for the review must be submitted to the department not
later than thirty days after the date the department issues the
initial debt summary report. The department shall conduct the
review on receipt of a timely request and issue a revised debt
summary report. If the department has withheld money from payment
due the exiting operator under division (A) of section 5111.681 of
the Revised Code, the department shall issue the revised debt
summary report not later than ninety days after the date the
department receives the timely request for the review unless the
department and exiting operator or affiliated operator agree to a
later date. The exiting operator or affiliated operator may submit
information to the department explaining what the operator
contests before and during the review, including documentation of
the amount of any debt the department owes the operator. The
exiting operator or affiliated operator may submit additional
information to the department not later than thirty days after the
department issues the revised debt summary report. The revised
debt summary report becomes the final debt summary report
thirty-one days after the department issues the revised debt
summary report unless the exiting operator or affiliated operator
timely submits additional information to the department. If the
exiting operator or affiliated operator timely submits additional
information to the department, the department shall consider the
additional information and issue a final debt summary report not
later than sixty days after the department issues the revised debt
summary report unless the department and exiting operator or
affiliated operator agree to a later date.

Each debt summary report the department issues under this
section shall include the department's findings and the amount of
debt the department determines the exiting operator owes the
department and United States centers for medicare and medicaid
services under the medicaid program. The department shall explain
its findings and determination in each debt summary report.

The exiting operator, and an affiliated operator who executes
a successor liability agreement under section 5111.681 of the
Revised Code, may request, in accordance with Chapter 119. of the
Revised Code, an adjudication regarding a finding in a final debt
summary report that pertains to an audit or alleged overpayment
made under the medicaid program to the exiting operator.
The
adjudication shall be consolidated with any other uncompleted
adjudication that concerns a matter addressed in the final debt
summary report.

Sec. 5111.686. The department of job and family services
shall release the actual amount withheld under division (A) of
section 5111.681 of the Revised Code, less any amount the exiting
operator owes the department and United States centers for
medicare and medicaid services under the medicaid program, as
follows:

(A) Ninety-one days after the date the exiting operator files
a properly completed cost report required by section 5111.682 of
the Revised Code unlessUnless the department issues the initial
debt summary report required by section 5111.685 of the Revised
Code not later than ninetysixty days after the date the exiting
operator files the properly completed cost report required by
section 5111.682 of the Revised Code, sixty-one days after the
date the exiting operator files the properly completed cost
report;

(B) Not later than thirty days after the exiting operator
agrees to a final fiscal audit resulting from the report required
by section 5111.685 of the Revised Code ifIf the department
issues the initial debt summary report required by section
5111.685 of the Revised Code not later than ninetysixty days
after the date the exiting operator files a properly completed
cost report required by section 5111.682 of the Revised Code, not
later than the following:

(1) Thirty days after the deadline for requesting an
adjudication under section 5111.685 of the Revised Code regarding
the final debt summary report if the exiting operator, and an
affiliated operator who executes a successor liability agreement
under section 5111.681 of the Revised Code, fail to request the
adjudication on or before the deadline;

(2) Thirty days after the completion of an adjudication of
the final debt summary report if the exiting operator, or an
affiliated operator who executes a successor liability agreement
under section 5111.681 of the Revised Code, requests the
adjudication on or before the deadline for requesting the
adjudication.

(C) Ninety-one days after the date the department waives the
cost report requirement of section 5111.682 of the Revised Code
unlessUnless the department issues the initial debt summary
report required by section 5111.685 of the Revised Code not later
than ninetysixty days after the date the department waives the
cost report requirement of section 5111.682 of the Revised Code,
sixty-one days after the date the department waives the cost
report requirement;

(D) Not later than thirty days after the exiting operator
agrees to a final fiscal audit resulting from the report required
by section 5111.685 of the Revised Code ifIf the department
issues the initial debt summary report required by section
5111.685 of the Revised Code not later than ninetysixty days
after the date the department waives the cost report requirement
of section 5111.682 of the Revised Code, not later than the
following:

(1) Thirty days after the deadline for requesting an
adjudication under section 5111.685 of the Revised Code regarding
the final debt summary report if the exiting operator, and an
affiliated operator who executes a successor liability agreement
under section 5111.681 of the Revised Code, fail to request the
adjudication on or before the deadline;

(2) Thirty days after the completion of an adjudication of
the final debt summary report if the exiting operator, or an
affiliated operator who executes a successor liability agreement
under section 5111.681 of the Revised Code, requests the
adjudication on or before the deadline for requesting the
adjudication.

Sec. 5111.688. (A) All amounts withheld under section
5111.681 of the Revised Code from payment due an exiting operator
under the medicaid program shall be deposited into the medicaid
payment withholding fund created by the controlling board pursuant
to section 131.35 of the Revised Code. Money in the fund shall be
used as follows:

(1) To pay an exiting operator when a withholding is released
to the exiting operator under section 5111.686 or 5111.687 of the
Revised Code;

(2) To pay the department of job and family services and
United States centers for medicare and medicaid services the
amount an exiting operator owes the department and United States
centers under the medicaid program.

(B) Amounts paid from the medicaid payment withholding fund
pursuant to division (A)(2) of this section shall be deposited
into the appropriate department fund.

Sec. 5111.6885111.689. The director of job and family
services shall adopt rules under section 5111.02 of the Revised
Code to implement sections 5111.65 to 5111.6885111.689 of the
Revised Code, including rules applicable to an exiting operator
that provides written notification under section 5111.66 of the
Revised Code of a voluntary withdrawal of participation. Rules
adopted under this section shall comply with section 1919(c)(2)(F)
of the "Social Security Act," 79 Stat. 286 (1965), 42 U.S.C.
1396r(c)(2)(F), regarding restrictions on transfers or discharges
of nursing facility residents in the case of a voluntary
withdrawal of participation. The rules may prescribe a medicaid
reimbursement methodology and other procedures that are applicable
after the effective date of a voluntary withdrawal of
participation that differ from the reimbursement methodology and
other procedures that would otherwise apply.

Sec. 5111.874. (A) As used in sections 5111.874 to 5111.8710
of the Revised Code:

"Home and community-based services" has the same meaning as
in section 5123.01 of the Revised Code.

"ICF/MR services" means intermediate care facility for the
mentally retarded services covered by the medicaid program that an
intermediate care facility for the mentally retarded provides to a
resident of the facility who is a medicaid recipient eligible for
medicaid-covered intermediate care facility for the mentally
retarded services.

"Intermediate care facility for the mentally retarded" means
an intermediate care facility for the mentally retarded that is
certified as in compliance with applicable standards for the
medicaid program by the director of health in accordance with
Title XIX of the "Social Security Act," 79 Stat. 286 (1965), 42
U.S.C. 1396, as amended, and licensed as a residential facility
under section 5123.19 of the Revised Code.

"Residential facility" has the same meaning as in section
5123.19 of the Revised Code.

(B) For the purpose of increasing the number of slots
available for home and community-based services and subject to
sections 5111.877 and 5111.878 of the Revised Code, the operator
of an intermediate care facility for the mentally retarded may
convert all of the beds in the facility from providing ICF/MR
services to providing home and community-based services if all of
the following requirements are met:

(1) The operator provides the directors of health, job and
family services, and developmental disabilities at least ninety
days' notice of the operator's intent to relinquish the facility's
certification as an intermediate care facility for the mentally
retarded and to begin providing home and community-based services.

(2) The operator complies with the requirements of sections
5111.65 to 5111.6885111.689 of the Revised Code regarding a
voluntary termination as defined in section 5111.65 of the Revised
Code if those requirements are applicable.

(3) The operator notifies each of the facility's residents
that the facility is to cease providing ICF/MR services and inform
each resident that the resident may do either of the following:

(a) Continue to receive ICF/MR services by transferring to
another facility that is an intermediate care facility for the
mentally retarded willing and able to accept the resident if the
resident continues to qualify for ICF/MR services;

(b) Begin to receive home and community-based services
instead of ICF/MR services from any provider of home and
community-based services that is willing and able to provide the
services to the resident if the resident is eligible for the
services and a slot for the services is available to the resident.

(4) The operator meets the requirements for providing home
and community-based services, including the following:

(a) Such requirements applicable to a residential facility if
the operator maintains the facility's license as a residential
facility;

(b) Such requirements applicable to a facility that is not
licensed as a residential facility if the operator surrenders the
facility's residential facility license under section 5123.19 of
the Revised Code.

(5) The director of developmental disabilities approves the
conversion.

(C) The notice to the director of developmental disabilities
under division (B)(1) of this section shall specify whether the
operator wishes to surrender the facility's license as a
residential facility under section 5123.19 of the Revised Code.

(D) If the director of developmental disabilities approves a
conversion under division (B) of this section, the director of
health shall terminate the certification of the intermediate care
facility for the mentally retarded to be converted. The director
of health shall notify the director of job and family services of
the termination. On receipt of the director of health's notice,
the director of job and family services shall terminate the
operator's medicaid provider agreement that authorizes the
operator to provide ICF/MR services at the facility. The operator
is not entitled to notice or a hearing under Chapter 119. of the
Revised Code before the director of job and family services
terminates the medicaid provider agreement.

Sec. 5111.875. (A) For the purpose of increasing the number
of slots available for home and community-based services and
subject to sections 5111.877 and 5111.878 of the Revised Code, a
person who acquires, through a request for proposals issued by the
director of developmental disabilities, a residential facility
that is an intermediate care facility for the mentally retarded
and for which the license as a residential facility was previously
surrendered or revoked may convert some or all of the facility's
beds from providing ICF/MR services to providing home and
community-based services if all of the following requirements are
met:

(1) The person provides the directors of health, job and
family services, and developmental disabilities at least ninety
days' notice of the person's intent to make the conversion.

(2) The person complies with the requirements of sections
5111.65 to 5111.6885111.689 of the Revised Code regarding a
voluntary termination as defined in section 5111.65 of the Revised
Code if those requirements are applicable.

(3) If the person intends to convert all of the facility's
beds, the person notifies each of the facility's residents that
the facility is to cease providing ICF/MR services and informs
each resident that the resident may do either of the following:

(a) Continue to receive ICF/MR services by transferring to
another facility that is an intermediate care facility for the
mentally retarded willing and able to accept the resident if the
resident continues to qualify for ICF/MR services;

(b) Begin to receive home and community-based services
instead of ICF/MR services from any provider of home and
community-based services that is willing and able to provide the
services to the resident if the resident is eligible for the
services and a slot for the services is available to the resident.

(4) If the person intends to convert some but not all of the
facility's beds, the person notifies each of the facility's
residents that the facility is to convert some of its beds from
providing ICF/MR services to providing home and community-based
services and inform each resident that the resident may do either
of the following:

(a) Continue to receive ICF/MR services from any provider of
ICF/MR services that is willing and able to provide the services
to the resident if the resident continues to qualify for ICF/MR
services;

(b) Begin to receive home and community-based services
instead of ICF/MR services from any provider of home and
community-based services that is willing and able to provide the
services to the resident if the resident is eligible for the
services and a slot for the services is available to the resident.

(5) The person meets the requirements for providing home and
community-based services at a residential facility.

(B) The notice provided to the directors under division
(A)(1) of this section shall specify whether some or all of the
facility's beds are to be converted. If some but not all of the
beds are to be converted, the notice shall specify how many of the
facility's beds are to be converted and how many of the beds are
to continue to provide ICF/MR services.

(C) On receipt of a notice under division (A)(1) of this
section, the director of health shall do the following:

(1) Terminate the certification of the intermediate care
facility for the mentally retarded if the notice specifies that
all of the facility's beds are to be converted;

(2) Reduce the facility's certified capacity by the number of
beds being converted if the notice specifies that some but not all
of the beds are to be converted.

(D) The director of health shall notify the director of job
and family services of the termination or reduction under division
(C) of this section. On receipt of the director of health's
notice, the director of job and family services shall do the
following:

(1) Terminate the person's medicaid provider agreement that
authorizes the person to provide ICF/MR services at the facility
if the facility's certification was terminated;

The person is not entitled to notice or a hearing under
Chapter 119. of the Revised Code before the director of job and
family services terminates or amends the medicaid provider
agreement.

Sec. 5111.894. The state administrative agency may establish
one or more waiting lists for the assisted living program. Only
individuals eligible for the medicaid program may be placed on a
waiting list.(A) The state administrative agency shall establish
a home first component of the assisted living program under which
eligible individuals may be enrolled in the assisted living
program in accordance with this section. An individual is eligible
for the assisted living program's home first component if all of
the following apply:

(1) The individual is eligible for the assisted living
program.

(2) The individual is on the unified waiting list established
under section 173.404 of the Revised Code.

(3) At least one of the following applies:

(a) The individual has been admitted to a nursing facility.

(b) A physician has determined and documented in writing that
the individual has a medical condition that, unless the individual
is enrolled in home and community-based services such as the
assisted living program, will require the individual to be
admitted to a nursing facility within thirty days of the
physician's determination.

(c) The individual has been hospitalized and a physician has
determined and documented in writing that, unless the individual
is enrolled in home and community-based services such as the
assisted living program, the individual is to be transported
directly from the hospital to a nursing facility admitted.

(d) Both of the following apply:

(i) The individual is the subject of a report made under
section 5101.61 of the Revised Code regarding abuse, neglect, or
exploitation or such a report referred to a county department of
job and family services under section 5126.31 of the Revised Code
or has made a request to a county department for protective
services as defined in section 5101.60 of the Revised Code.

(ii) A county department of job and family services and an
area agency on aging have jointly documented in writing that,
unless the individual is enrolled in home and community-based
services such as the assisted living program, the individual
should be admitted to a nursing facility.

(e) The individual resided in a residential care facility for
at least six months immediately before applying for the assisted
living program and is at risk of imminent admission to a nursing
facility because the costs of residing in the residential care
facility have depleted the individual's resources such that the
individual is unable to continue to afford the cost of residing in
the residential care facility.

(B) Each month, each area agency on aging shall determine
whether any individual who residesidentify individuals residing
in the area that the area agency on aging serves and is on a
waiting listwho are eligible for the home first component of the
assisted living program has been admitted to a nursing facility.
IfWhen an area agency on aging
determines thatidentifies such
an individual has been admitted to a nursing facility and
determines that there is a vacancy in a residential care facility
participating in the assisted living program that is acceptable to
the individual, the agency shall notify the long-term care
consultation program administrator serving the area in which the
individual resides about the determination. The administrator
shall determine whether the assisted living program is appropriate
for the individual and whether the individual would rather
participate in the assisted living program than continue
residingor begin to reside in thea nursing facility. If the administrator
determines that the assisted living program is appropriate for the
individual and the individual would rather participate in the
assisted living program than continue
residingor begin to reside
in thea nursing facility, the administrator shall so notify the
state administrative agency.

Onagency. On receipt of the notice from the administrator,
the state administrative agency shall approve the individual's
enrollment in the assisted living program regardless of anythe
unified waiting list for the assisted living programestablished
under section 173.404 of the Revised Code, unless the enrollment
would cause the assisted living program to exceed any limit on the
number of individuals who may participate in the program as set by
the United States secretary of health and human services when the
medicaid waiver authorizing the program is approved. Each

(C) Each quarter, the state administrative agency shall
certify to the director of budget and management the estimated
increase in costs of the assisted living program resulting from
enrollment of individuals in the assisted living program pursuant
to this section.

Section 3. That Section 209.20 of Am. Sub. H.B. 1 of the
128th General Assembly be amended to read as follows:

Sec. 209.20. LONG-TERM CARE

Pursuant to an interagency agreement, the Department of Job
and Family Services shall designate the Department of Aging to
perform assessments under section 5111.204 of the Revised Code.
The Department of Aging shall provide long-term care consultations
under section 173.42 of the Revised Code to assist individuals in
planning for their long-term health care needs. The foregoing
appropriation items 490423, Long Term Care Budget – State, and
490623, Long Term Care Budget, may be used to provide the
preadmission screening and resident review (PASRR), which includes
screening, assessments, and determinations made under sections
5111.02, 5111.204, 5119.061, and 5123.021 of the Revised Code.

The foregoing appropriation items 490423, Long Term Care
Budget - State, and 490623, Long Term Care Budget, may be used to
assess and provide long-term care consultations to clients
regardless of Medicaid eligibility.

The Director of Aging shall adopt rules under section 111.15
of the Revised Code governing the nonwaiver funded PASSPORT
program, including client eligibility. The foregoing appropriation
item 490423, Long Term Care Budget - State, may be used by the
Department of Aging to provide nonwaiver funded PASSPORT services
to persons the Department has determined to be eligible to
participate in the nonwaiver funded PASSPORT Program, including
those persons not yet determined to be financially eligible to
participate in the Medicaid waiver component of the PASSPORT
Program by a county department of job and family services.

The Department of Aging shall administer the Medicaid
waiver-funded PASSPORT Home Care Program, the Choices Program, the
Assisted Living Program, and the PACE Program as delegated by the
Department of Job and Family Services in an interagency agreement.
The foregoing appropriation item 490423, Long Term Care Budget -
State, shall be used to provide the required state match for
federal Medicaid funds supporting the Medicaid Waiver-funded
PASSPORT Home Care Program, the Choices Program, the Assisted
Living Program, and the PACE Program. The foregoing appropriation
items 490423, Long Term Care Budget - State, and 490623, Long Term
Care Budget, may also be used to support the Department of Aging's
administrative costs associated with operating the PASSPORT,
Choices, Assisted Living, and PACE programs.

The foregoing appropriation item 490623, Long Term Care
Budget, shall be used to provide the federal matching share for
all program costs determined by the Department of Job and Family
Services to be eligible for Medicaid reimbursement.

HOME FIRST PROGRAM

(A) As used in this section, "Long Term Care Budget Services"
includes the following existing programs: PASSPORT, Assisted
Living, Residential State Supplement, and PACE.

(B) On a quarterly basis, on receipt of the certified
expenditures related to sections 173.401, 173.351, 173.501, and
5111.894 of the Revised Code, the Director of Budget and
Management, in consultation with the Directors of Aging and Job
and Family Services, may do all of the following for fiscal years
2010 and 2011:

(1) Transfer cash from the Nursing Facility Stabilization
Fund (Fund 5R20), used by the Department of Job and Family
Services, to the PASSPORT/Residential State Supplement Fund (Fund
4J40), used by the Department of Aging. The

The transferred cash is hereby appropriated to appropriation
item 490610, PASSPORT/Residential State Supplement.

(2) If receipts credited toAuthorize expenditures from the
PASSPORT Fund (Fund 3C40) for amounts that exceed the amounts
appropriated from receipts credited to the fund, the Director of
Aging may request the Director of Budget and Management to
authorize expenditures from the fund in excess of the amounts
appropriated. Upon the approval of the Director of Budget and
Management, theAny additional authorized amounts are hereby
appropriated.

(3) If receipts credited toAuthorize expenditures from the
Interagency Reimbursement Fund (Fund 3G50) for amounts that exceed
the amounts appropriated from receipts credited to the fund, the
Director of Job and Family Services may request the Director of
Budget and Management to authorize expenditures from the fund in
excess of the amounts appropriated. Upon the approval of the
Director of Budget and Management, theAny additional authorized
amounts are hereby appropriated.

(C) Not later than thirty days after the Director of Budget
and Management receives certification of expenditures specified in
division (B) of this section, the Executive Director of Executive
Medicaid Management Administration shall submit a report to the
General Assembly in accordance with section 101.68 of the Revised
Code and to the chairs and ranking minority members of the
committees of the House of Representatives and Senate to which the
biennial budget bill is referred. The report shall describe and
document the criteria and data the Department of Aging, Department
of Job and Family Services, and Office of Budget and Management
use to justify a transfer of funds under division (B) of this
section, including spending and utilization trends for PASSPORT,
PACE, assisted living, and nursing facility services. In addition
to providing the information for the transfer of funds, the report
shall include the following:

(1) In the case of reports for transfers that occur during
fiscal year 2010, the descriptions and documents of the criteria
and data used to justify other such transfers that previously
occurred during that fiscal year;

(2) In the case of reports for transfers that occur during
fiscal year 2011, the descriptions and documents of the criteria
and data used to justify other such transfers that previously
occurred during that fiscal year and fiscal year 2010.

The Directors of Aging, Job and Family Services, and Budget
and Management shall provide the Executive Director of the
Executive Medicaid Management Administration with all information
the Executive Director needs to prepare the reports required by
this division.

(D) The individuals placed in Long Term Care Budget Services
pursuant to this section shall be in addition to the individuals
placed in Long Term Care Budget Services during fiscal years 2010
and 2011 before any transfers to appropriation item 490423, Long
Term Care Budget-State, are made under this section.

ALLOCATION OF PACE SLOTS

In order to effectively administer and manage growth within
the PACE Program, the Director of Aging may, as the director deems
appropriate and to the extent funding is available, expand the
PACE Program to regions of Ohio beyond those currently served by
the PACE Program. In implementing the expansion, the Director may
not decrease the number of residents of Cuyahoga and Hamilton
counties and parts of Butler, Clermont, and Warren counties who
are participating in the PACE Program below the number of
residents of those counties and parts of counties who were
enrolled in the PACE Program on July 1, 2008.

Section 4. That existing Section 209.20 of Am. Sub. H.B. 1 of
the 128th General Assembly is hereby repealed.

Section 5. During fiscal years 2012 and 2013, on receipt of
certified expenditures related to sections 173.401, 173.351,
173.501, and 5111.894 of the Revised Code, the Director of Budget
and Management shall transfer cash from the Nursing Facility
Stabilization Fund (Fund 5R20), used by the Department of Job and
Family Services, to the PASSPORT/Residential State Supplement Fund
(Fund 4J40), used by the Department of Aging.

If receipts credited to the PASSPORT Fund (Fund 3C40) exceed
the amounts appropriated from the fund in fiscal years 2012 and
2013, the Director of Aging shall request the Director of Budget
and Management to authorize expenditures from the fund in excess
of the amounts appropriated.

If receipts credited to the Interagency Reimbursement Fund
(Fund 3G50) exceed the amounts appropriated from the fund in
fiscal years 2012 and 2013, the Director of Job and Family
Services shall request the Director of Budget and Management to
authorize expenditures from the fund in excess of the amounts
appropriated.

Section 6. (A) As used in this section, "population" means
that shown by the 2000 regular federal census.

(B) Until December 31, 2010, the Director of Health shall
accept, for review under section 3702.52 of the Revised Code,
certificate of need applications for an increase in beds in an
existing nursing home if all of the following conditions are met:

(1) The proposed increase is attributable solely to a
relocation of beds registered under section 3701.07 of the Revised
Code as long-term care beds from an existing hospital located in a
county with a population of at least forty thousand persons and
not more than forty-five thousand persons to an existing nursing
home located in a county that has a population of at least one
million persons and not more than one million one hundred thousand
persons and is contiguous to the county from which the beds are to
be relocated.

(2) Not more than fifteen beds are proposed for relocation.

(3) After the proposed relocation, there will be existing
long-term care beds, as defined in section 3702.51 of the Revised
Code, remaining in the county from which the beds are relocated.

(4) The beds are proposed to be licensed as nursing home beds
under Chapter 3721. of the Revised Code.

(C) In reviewing a certificate of need application accepted
under this section, the Director shall not deny the application on
the grounds that the existing hospital from which the beds are to
be relocated is not providing services in all or part of the
long-term care beds at the hospital or has not provided services
in all or part of those long-term care beds for at least three
hundred sixty-five days within the twenty-four months immediately
preceding the date the certificate of need application is filed
with the Director, as otherwise required by a rule adopted under
section 3702.57 of the Revised Code.